Ciprofloxacin

C difficile risk
High
Oral Bioavailability
Excellent
Cost
IV $7/d PO $0.20/d

Dosing

Defined criteria for use and/or important safety considerations. See below for more information.

IVPO400 mg IV q12h500 - 750 mg PO q12h

400 mg IV q8h

CrCl > 30 mL/minCrCl 10 - 30 mL/minCrCl < 10 mL/minNo renal adjustment required400 mg IV q24h

  • CNS and Pseudomonas infection: 400 mg IV q12h 400 mg IV q24h

CrCl > 30 mL/minCrCl < 30 mL/minNo renal adjustment required500 - 750 mg PO q24h

IVPO400 mg IV q24h

  • Give dose after dialysis on HD days500 - 750 mg PO q24h

  • Give dose after dialysis on HD days

IVPO400 mg IV q24h500 - 750 mg PO q24h

IVPO400 mg IV q12h500 - 750 mg PO q12h

General Information

  • Pyelonephritis

  • Part of combination empiric therapy of severe pneumonia where Pseudomonas or other resistant Gram-negative infections are suspected

  • Part of combination therapy of high-risk febrile neutropenia for patients with a severe Beta-lactam allergy

  • Treatment of intra-abdominal infections in patients who cannot receive Beta-lactam or aminoglycoside-containing regimens

  • Treatment of a documented Gram-negative infection due to a microorganism resistant to other antibiotics or when another antibiotic is contraindicated; (e.g. UTI)

  • N. meningitidis prophylaxis

Alternative:

  • Bone & joint infections due to susceptible microorganisms and no other oral option

  • Infectious diarrhea when treatment is indicated for susceptible microorganisms

First line for uncomplicated UTIs

Monitor QTc in patients with increased risk

  • QTc prolongation

  • Dysglycemia

  • Tendinopathy and rupture

  • GI upset

  • Rash

  • Retinal detachment

  • CNS toxicity including confusion, psychosis

  • Weakness exacerbation in myasthenia gravis

  • CYP1A2 inhibitor - Multiple interactions possible.

  • QTc prolongation - Increased risk with other agents that prolong QTc.

  • Divalent & trivalent cations including Al, Ca, Fe, Mg (antacids, dairy products, iron supplements, some enteral feeds) - Decreased absorption

  • Cyclosporine - Increased levels of cyclosporine

  • Warfarin - Increased INR

  • Methadone - Lowered seizure threshold

Oral Ciprofloxacin Administration

  • Avoid dairy products, antacids, and other sources of divalent cations (Ca, Fe, Mg, Al, Zn) which can chelate ciprofloxacin and prevent absorption

  • Must hold continuous tube feeding 2 h before and 2 h after administration

  • Do not use suspension

Antimicrobial class: Fluoroquinolone

Pregnancy category: C

Average serum half life: 4 hours

Biliary penetration: Therapeutic

CSF penetration: Variable (IV); not first line

Lung penetration: Therapeutic

Urine penetration: Therapeutic

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